Many NHS hospital staff would not be happy with the standard of care they would get if they were patients at the place they work, the government's health watchdog said today after the world's biggest survey of employee opinion.

After interviewing more than 128,000 staff in NHS trusts across England, the Healthcare Commission survey found only 42% would be happy with standards at their own establishment. A quarter said they would be definitely unhappy and 34% did not have a view. The study, which showed continuing concern about lack of handwashing facilities and abuse of NHS staff, raised doubts about the effectiveness of the government's drive to create a patient-centred NHS.

Just under half the staff in hospitals said care of patients was their trust's top priority, but 25% said it was not. The survey did not ask what other priorities could be regarded as more important than the patients the organisation was supposed to serve.

An analysis of the results by the Guardian showed wide variation between trusts. In West Hertfordshire hospitals NHS trust, only 21% of staff said they would be happy as patients and 48% said they would be unhappy. Other trusts with high unhappiness scores included: Mid Staffordshire general hospitals; Queen Mary's, Sidcup; United Lincolnshire hospitals; Northamptonshire healthcare; Royal Cornwall hospitals; Devon Partnership trust; and Hillingdon primary care trust.

A more positive view came from staff at Queen Victoria foundation hospital in East Grinstead, West Sussex, where 86% of staff would be happy to be patients and only 2% unhappy. Other hospitals showing a high level of employee satisfaction with standards included the Royal Marsden, south London, the Royal National hospital for rheumatic diseases, Bath, and the Royal Brompton and Harefield trust, south London.

The commission found the government's drive to combat MRSA by insisting on more rigorous standards of cleanliness had had only limited success. Almost two- thirds of staff in acute hospitals said hand-washing facilities were always available when needed by staff and 55% said they were always available for patients. The proportions had been almost identical in the previous year's survey.

The commission said it remained worried about violence and harassment. Last year 11% of hospital staff experienced physical violence from patients and 26% suffered bullying, harassment or abuse from patients. The survey found 18% were abused by other staff - the highest figure for three years. Paramedics were the most abused. In ambulance trusts, 48% of staff experienced bullying, harassment or abuse from patients or their relatives.

But the commission was pleased to discover that staff in other parts of the NHS felt less stressed than ever before and suffered fewer work-related injuries. They also saw fewer medical errors or "near-misses" in which patients might have come to harm. In 2006, 38% of staff encountered at least one such incident, compared with 49% in 2003.